Ethische Aspekte der medikamentösen Behandlung dementer Patienten

Abstract.Definition of the problem: The development and use of drugs aimed at a positive influence on the cognitive decline in patients suffering from Alzheimer's disease raises a number of ethical issues. Arguments: Among other things, these issues are concerned with the significance of these drugs for the patient's subjective well-being and quality of life and with aspects of informed consent to the use of these drugs, particularly in connection with their use in scientific medical research. Conclusion: The value and significance of antidementia drugs depends not only on their effect on cognitive decline, but also on their wider significance for patients' quality of life and their primary carers. The subjective experience of those directly involved deserves more attention in research and practice.Zusammenfassung. Die Entwicklung und die Verwendung von Antidementiva, die die Verzögerung des kognitiven Abbaus bei Alzheimer Patienten zum Ziel haben, werfen eine Reihe ethischer Fragen auf. Diese beziehen sich, neben anderen, auf die Bedeutung dieser Medikamente für das subjektive Wohlbefinden und die Lebensqualität des Patienten und auf Aspekte der Zustimmung zur Verwendung dieser Mittel nach Information, insbesondere im Rahmen der medizinisch-wissenschaftlichen Forschung. Der Wert und die Bedeutung der Antidementiva hängt nicht nur vom Effekt auf den kognitiven Abbau ab, sondern auch im weitesten Sinne von der Auswirkung auf die Lebensqualität der Patienten und ihrer primären Versorger. Die subjektiven Erfahrungen der unmittelbar Betroffenen bedürfen daher mehr Aufmerksamkeit als bisher, sowohl in der Forschung als auch in der Praxis.

[1]  C. Filley,et al.  Ethical concerns in the use of palliative drug treatment for Alzheimer's Disease. , 1996, The Journal of neuropsychiatry and clinical neurosciences.

[2]  P. Whitehouse,et al.  Emergency Research and Research Involving Subjects with Cognitive Impairment: Ethical Connections and Contrasts , 1997, Journal of The American Geriatrics Society.

[3]  R J Harvey,et al.  Drug treatments for Alzheimer's disease , 1997, BMJ.

[4]  D. Knopman Metrifonate for Alzheimer's disease , 1998, Neurology.

[5]  G. Wilcock,et al.  The cholinergic hypothesis of Alzheimer’s disease: a review of progress , 1999, Journal of neurology, neurosurgery, and psychiatry.

[6]  M. Lachs,et al.  Should patients with Alzheimer's disease be told their diagnosis? , 1992, The New England journal of medicine.

[7]  G. Naglie,et al.  The Use of Medications for Cognitive Enhancement , 2001, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[8]  A. Roses,et al.  The clinical introduction of genetic testing for Alzheimer disease. An ethical perspective. , 1997, JAMA.

[9]  P. Whitehouse,et al.  Guidelines for Addressing Ethical and Legal Issues in Alzheimer Disease Research: A Position Paper , 1994, Alzheimer disease and associated disorders.

[10]  P. Whitehouse,et al.  Fairhill Guidelines on Ethics of the Care of People With Alzheimer's Disease: A Clinical Summary * , 1995, Journal of the American Geriatrics Society.

[11]  R. Berghmans Ethical Hazards of the Substituted Judgement Test in Decision Making Concerning the End of Life of Dementia Patients , 1997, International journal of geriatric psychiatry.

[12]  A. Burns,et al.  New drugs for Alzheimer's disease , 1999, British Journal of Psychiatry.

[13]  J. Vollmann Aufklärung und Einwilligung in der Psychiatrie , 2000 .

[14]  J. Oldham,et al.  Uninformed decisionmaking. The case of surrogate research consent. , 1997, The Hastings Center report.

[15]  S. Ferris,et al.  Suicide in two patients with a diagnosis of probable Alzheimer disease. , 1999, Alzheimer disease and associated disorders.

[16]  G. Sachs Dementia and the Goals of Care , 1998, Journal of the American Geriatrics Society.

[17]  N. Kass,et al.  Trust, The fragile foundation of contemporary biomedical research. , 1996, The Hastings Center report.

[18]  J. Magaziner,et al.  Proxies' Decisions About Clinical Research Participation for Their Charges , 1997, Journal of the American Geriatrics Society.

[19]  D. Knopman,et al.  Clinical research designs for emerging treatments for Alzheimer disease: moving beyond placebo-controlled trials. , 1998, Archives of neurology.

[20]  K. Glass,et al.  Proposed Guidelines for the Participation of Persons with Dementia as Research Subjects , 2015, Perspectives in biology and medicine.

[21]  J. Karlawish,et al.  What is the Quality of the Reporting of Research Ethics in Publications of Nursing Home Research? , 1999, Journal of the American Geriatrics Society.

[22]  N. Cutler,et al.  Recent Developments in the Drug Treatment of Alzheimer’s Disease , 1999, Drugs & aging.

[23]  H. Lauter,et al.  Dürfen Ärzte mit Demenzkranken forschen? Analyse des Problemfeldes Forschungsbedarf und Einwilligungsproblematik , 1995 .

[24]  C. Cassel,et al.  Treatment choices at the end of life: a comparison of decisions by older patients and their physician-selected proxies. , 1989, The Gerontologist.

[25]  R. Evans,et al.  Pharmacologic treatment of cognition in Alzheimer's dementia , 1998, Neurology.

[26]  R. Schulz,et al.  The perspective of the patient with Alzheimer's disease: a neglected dimension of dementia research. , 1993, The Gerontologist.

[27]  S. Post,et al.  Future scenarios for the prevention and delay of Alzheimer disease onset in high-risk groups. An ethical perspective. , 1999, American journal of preventive medicine.

[28]  D. Melzer New drug treatment for Alzheimer's disease: lessons for healthcare policy , 1998, BMJ.

[29]  L. Schneider,et al.  Long-term tacrine (Cognex) treatment , 1996, Neurology.

[30]  Slowing the progression of Alzheimer disease: ethical issues. , 1997, Alzheimer disease and associated disorders.

[31]  H. Vanderpool,et al.  False data & the therapeutic misconception: two urgent problems in research ethics. False data and last hopes: enrolling ineligible patients in clinical trials. , 1987, The Hastings Center report.

[32]  S. Post The Fear of Forgetfulness: A Grassroots Approach to an Ethics of Alzheimer’s Disease , 1998, The Journal of Clinical Ethics.

[33]  M N Rossor,et al.  Presymptomatic cognitive deficits in individuals at risk of familial Alzheimer's disease. A longitudinal prospective study. , 1998, Brain : a journal of neurology.

[34]  J. Karlawish,et al.  Is the placebo control obsolete in a world after donepezil and vitamin E? , 1998, Archives of neurology.

[35]  Academisch Ziekenhuis Cholinesteraseremmers bij de ziekte van Alzheimer: voorlopige aanbevelingen voor de praktijk , 1998 .

[36]  S. Gauthier,et al.  Rivastigmine for Alzheimer's disease: Canadian interpretation of intermediate outcome measures and cost implications. , 2000, Clinical Therapeutics.

[37]  P. Whitehouse,et al.  Emerging Antidementia Drugs: A Preliminary Ethical View , 1998, Journal of the American Geriatrics Society.

[38]  J. Tenney,et al.  Informed consent by proxy. An issue in research with elderly patients. , 1986, The New England journal of medicine.

[39]  K. Davis Cholinesterase Inhibitors in Alzheimer's Disease , 1994, Neuropsychopharmacology.

[40]  M. Ratain,et al.  Perceptions of cancer patients and their physicians involved in phase I trials. , 1995, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[41]  M. Farlow New treatments in Alzheimer disease and the continued need for placebo-controlled trials. , 1998, Archives of neurology.

[42]  P S Appelbaum,et al.  False hopes and best data: consent to research and the therapeutic misconception. , 1987, The Hastings Center report.

[43]  K. Davis,et al.  The search for disease-modifying treatment for Alzheimer's disease , 1997, Neurology.